7. PTSD + Adjustment Disorder

Question 1

What is post traumatic stress disorder?

Answer 1

Response to extreme life stressing event

1. Re-experiencing (nightmares, flashbacks)
2. avoidance (of stimuli associated with the trauma)
3. hyperarousal (sleep problems, hypervigilance, exaggerated startle)

***Sx for 1m before Dx

Question 2

Outline the pathophysiology of PTSD

Answer 2

MRI implicates the anterior cingulate area, with failure to inhibit amygdala activation, decreased amygdala threshold to fearful stimuli

Lower cortisol = lower inhibition of traumatic memory retrieval and sympathetic response

Question 3

How is PTSD treated?

Answer 3

Sx <3m of trauma =

• risk assessment
• watchful waiting (mild Sx <4w)
• trauma focused CBT
• short term zopiclone for sleep disturbance

Sx >3m of trauma =

• trauma focused CBT
• Eye Movement Desensitisation Reprocessing (EMDR) – follow visual stimulus while recounting past events
• SSRIs (paroxetine), TCA (amitriptyline), MAOIs (phenelzine), SGA

Question 4

What are the S+S of PTSD?

Answer 4

Reliving in vivid nightmare/flashbacks - often with autonomic arousal (increased pulse, BP, sweating)

Anxiety

Panic attacks

Avoidance, hypervigilance

Sleep disturbance

Poor concentration

Drug/alcohol misuse

Anger

Question 5

How should PTSD be investigated?

Answer 5

Questionnaires = Trauma Screen Questionnaire (TSQ), Post-traumatic diagnostic scale

CT head = is injury suspected

Question 6

Give a DDx for PTSD

Answer 6

Psychiatric = adjustment disorder, acute stress reaction, bereavement, dissociative disorder, mood/anxiety disorders, personality disorder

Organic = head trauma, substance misuse

Question 7

What is adjustment disorder?

Answer 7

Group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event –> significant distress, impairment in social functioning

Identifiable (non-catastrophic) psychosocial stress within 1m of onset of Sx

Sx must be present for <6m

Question 8

How does adjustment disorder present?

Answer 8

Sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed and thoughts of suicide, performing poorly in school/work

Depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three.

Question 9

How is adjustment disorder diagnosed?

Answer 9

DSM-5 = Sx must clearly follow a stressor. The symptoms should be more severe than would be expected. There should not appear to be other underlying disorders. The symptoms that are present are not part of a normal grieving for the death of family member or other loved one

ICD-11

Question 10

Outline the management of adjustment disorder

Answer 10

Therapy

Medication for anxiety/depression Sx